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<br /> S1-,.Ml1,.t`~ °,a .s Edi, 'A" for a Var...,t/Sae, regardless of t39>v number (af so9f,s ",.., ... .,E. t. . &a,
<br /> t& _„e x qmuld he o,?. t„c,,, . r ,n chher the rimk.3I1`I x1PP1JCAvrr or Me LOCAL ACal N£,"."r
<br /> 5.
<br /> .se a ,x'ud, -p .m, w € .",. .�x� .,zip(":€r�€ tons me, ititiking 3 Copies, ..
<br /> TOP O ts.tl,a,I 'MARK ONLY 3.,N9, '.1...'�A'
<br /> Mark an (ll) in Bebox _w,, u) Be hem that taast d sc.t,t.es tine reason the farm is being completed,
<br /> 1, 1,AC'HXfYj1SrJ1INFORMAITON & ADDRI�S.S( U,Kif III COMP11-TEA))
<br /> 1. lea>a "tI mime and address ( l ,aim] location) of the underground tank(s),
<br /> Ips,£,: dd.res. MUST hava valid ph a
<br /> ie . l a*,aflcl
<br /> on inuding city wo and Ap code.
<br /> pp � r c.
<br /> Include .;:a, ,,t cross _sicoct and name of the oper<atsxr.
<br /> 3
<br /> Plhunnc nonr1 b... ,.r„shave an area ewe. If r€e na gln, itunibcr is the same, write "SAME7 in pnper toc�,km,,
<br /> ., Check a th Via, 7�,_�<,rm NW Ae f a sal.- g rJSPdr.SS a INER IIIE` (ex. Cft aRPORiV1 lElN, INDI a "t'UAl cm)
<br /> _..t,
<br /> .. �..- ec% the 2f7t . ._;d<tS; 3>{F.s tL, x ,cS% ,Pf ?"i,�,.✓..._9{,Sd�-.
<br /> S. If f a rF iy/Ss99 is Jocamd witlan ,d€ 1sz'.ze` rmemmien or other Indian trust lands, check r£1e kcia_a11:raksr3 ",I:S ,
<br /> 6, Indieate the .of the" SITL�
<br /> t. R'x.c„d We ETA. 11) s or ti, fN>, in The see „ provided,
<br /> if EsIS0P1-',.as n.I OWNER.a ER tfSt y .Tars. ICS s S. .It.Da llat,SS (aaI LYST BE,C(MIDI<1 uloj))
<br /> umview all Ir�at>s in so tw_;._. tmwn .a,3 ,,.d ia, are flhm same as SI+:.,`I"ION is if the same. wrhe TIANVI AS Shill scrAs
<br /> _ 111, TANK OWNER ( I CItsarll"xi a )
<br /> c >".a,.inta all items A As S.&M, .:3;ss .W r..,rs ,,.e the karate as ISIICMI'I(IN 1; If the same, who: "SA 111x1 AS INI°E .aa€ovs
<br /> this .>c£.k`ion. Be sure '::? c n,..,.uk 1 zr;NK tr rWIa,a.Iad�?HIP ITFI[i l>£:€.x,
<br /> rK BC OX I y OF I":C C 7VQiZNUK94 usT a,IDIg AnU I dfI,fi.t C'..£ I.Tie-r NUMBER( I""BE CXR 1U1
<br /> Timer your Board of I-?qualiz,wton (B0F',I l.,u storage tee account asmTer urhieh is required before your permit applit'atiz n
<br /> me be l9r cc,ssed. IaeostrEihn win Ac Itt 1_:add ensure that jul will receive a quarterly storage fee return in reporfing= ille
<br /> a3?.006 (6 nxill per g H ,e fee glaze on Be manlocr f ;.a4ic s placed in yetis' I,S-Ic. `I12e BOE, will Node persons caa;raxls, i'aoara
<br /> moyhnn, the saor'.age d4.c vi rctlie€.r MN not be vent If rp`rou do not have an acciaunt nu3111:x€r with the TIMI', or if you 1?4: any
<br /> q a,a,.abo s reprding be &e or cionnp%ions ;cave° call the BOF at 9Ifd-3235555 or write to the B01: at the follev ing "rc, rc.ss:
<br /> I'€.,,.gid of Equ.alintion, Er.,a,n,ncnial Par UK PD. Me 9INIT), Sacra9>1ewca, CA €9QW-0lk?1.
<br /> V. 1&13-11ytaL,t'LTM LIST Ia.Nd.PR 1A l tMg, l yllatl<I"I""1' amt,us F,I"II:<crt I,l`I`I 1I)
<br /> d€ -„'s- the met9 r s) swd by lie gowner ..dor operaosr in mcaing ter: P alwal-and State financial r sponsa iln-Y
<br /> .?q,>.?:.a,d virss:.0 St,m...'rY,-,, ..3 aa1 xictwa .-, State a,�.,bncy are exiernixt Front this requirement,
<br /> I, I:GAL y,Cr"ldirlCA ICI` S.Nll II111LINCa cSsDIBRlsSs"S
<br /> Check ONE JA)X for the addres, that -..h be baser# frsr B(YTIl 11RIN.= £I"L "mnO NS,
<br /> PPI,If;lll 1151 SIGN AND 1.,1073 THE',' .trtf it S4.S 04DI 1711 ;
<br /> I SI` IC.I ON y"CI °Ill. I,l (MLGU`, .0>lcal
<br /> Ther., and jurisdiction s,F;,,91 e , .:,re p... `.,twrat im-d and can be olxrained by calling die; State I:ImM (rlilij 9 3521. The
<br /> t € h,:, number ber ?9 ,. .aaApwd 1, the Arm aa,emy hmmveq t:Sis dumber must tie numerical and cannot contain any
<br /> IT the i<ro.Jl aprog _.,z,..s Me .>,.s.i<P, Board to ra9is8gS1 the fi:c311Cy number, please lease 3Y: i'S1+1nlr.
<br /> Er IS ITTE RJUI "()NS1Illl-,l.l.y,. Cap IME IE I a l h:;a'a l., A GT hsfC.° 'I I I'I SPEI . ,S"Ilia?F CIL 1'0, VERHIY'111P,
<br /> AC' i,IIIAC Y OFTHE IxvlS,sl ¢Ila"S.I.tsli.. 11115 ayPPLIC:NI10 NN(Y17 BP PR00O3 SED IF`TIE TY)E AC:C:;C➢IJIfp
<br /> Nl ,!v,13 V,R 1S NO`I' 141 I,.I i IN, s I€1' IXXIAL AG04CY IS TUNPONSIBIX Ifi ' E C:C)MPIA'rT"IO OF TIBi
<br /> 'LOCAL AGENCY OSI_ CtlaMN' 3NF,4s:<II,a,t R'I0N JXYX AN13 FOR FORWARDING ONE 1rC)R 'A'AND
<br /> zS095)(3XI U) la'llR 'Woo f.t: THE Iatafal.DWING A11131(El&i,
<br /> SIAaC:iInCARIdaaICISIS
<br /> I A Ian VVAT IFTR ILL`sat-,d R 1,o5CONI'ROL BOARD
<br /> e.jCI
<br /> NVI CISITiR
<br /> PD, BOX 52711
<br />
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